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Copper coil – IUD

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The IUD (Intra-Uterine Device) is a small plastic and copper T-shaped device that is placed in the uterus to prevent pregnancy. IUDs can be used by women of all ages, including childless women and those under 16.

Once fitted, an IUD can be left in place for five to 10 years, depending on the type.

How effective is it?

The IUD is over 99% effective in preventing pregnancy.

How does it work?

The IUD prevents pregnancy by releasing copper ions: chemicals in the copper which aren’t toxic but which kill sperm.

As the IUD is T-shaped, the arms physically prevent any fertilised eggs from implanting in the womb and developing into a foetus. The IUD makes the uterus a very hostile environment for sperm.

Advantages of the IUD

  • It can be fitted at any time as long as the woman is not already pregnant.
  • It is available at a range of sites including GUM and other sexual health clinics, GPs and abortion services.
  • It does not interrupt sex.
  • It has no effect on fertility or hormonal balance.

The IUD may also be used as emergency contraception if put in within five days of having unprotected sex.

Disadvantages of the IUD

It takes two appointments to have an IUD fitted, one for the initial chat and check-up and one for the actual fitting.

The fitting can be uncomfortable/painful, but local anaesthetic is usually used. The IUD needs to be fitted by a specially trained doctor or nurse.

It’s possible to develop a pelvic infection if the IUD is fitted while the woman has a sexually transmitted infection (STI).

The IUD may cause slightly longer and heavier periods and some women also find their periods become a little more painful; however, many women notice very little difference at all.

Very rarely, having the IUD fitted may make a small hole in the uterus. This is unlikely if the doctor or nurse fitting your IUD has lots of experience.

Hormonal coil – IUS

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The IUS (Intra-Uterine System or Mirena) is similar to the IUD. It’s a small plastic T-shaped device which is placed in the uterus. It contains the hormone progestogen. 

The IUS is a long-term contraceptive which can be left in place for between five to seven years depending on when it was fitted.

How does it work?

The progestogen released by the IUS works in several ways to prevent the woman from getting pregnant.

  • It thickens cervical mucus to prevent sperm from entering the canal to the womb and being able to reach an egg.
  • It thins the lining of the womb so that if an egg was fertilised it would not be able to implant.
  • It may on occasion stop eggs from being released (ovulation).
  • As the IUS is T-shaped, its arms physically prevent any fertilised eggs from implanting in the womb and developing into a foetus.

How effective is it?

The IUS is over 99% effective at preventing pregnancy.

Advantages of the IUS

  • It can be fitted at any time if the woman is not already pregnant.
  • It’s available at a range of sites, including CASH, GUM and other sexual health clinics, GPs and abortion services.
  • There’s no need to remember to take a pill.
  • It does not interrupt sex.

The IUS can cause periods to be shorter and lighter and for some women they may stop completely, though both periods and fertility return quickly when the IUS is removed.

Disadvantages of the IUS

  • It usually takes two appointments to get an IUS: one for the initial chat and check-up and one for the actual fitting.
  • The fitting can be uncomfortable/painful, but a local anaesthetic is generally used.
  • It needs to be fitted by a specially trained doctor or nurse.
  • Having a sexually transmitted infection while an IUS is being fitted risks a pelvic infection.

Having an IUS fitted may initially come with side effects like:

  • breast tenderness
  • spotty skin
  • headaches
  • irregular periods, which some women find annoying or worrying (for most women this settles within the first six to 12 months after fitting)
  • a small chance of developing an infection.

Very rarely, having the IUS fitted may make a small hole in the uterus. This is not likely if the doctor or nurse fitting the IUS has lots of experience.

Contraceptive injection

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The contraceptive injection, also known as the depo or depo-provera, is a long-acting contraception method containing the hormone progestogen. It has to be given every 12 weeks to work consistently.

The hormone is injected into a muscle, usually the bottom.

How does it work?

Its main way of working is to stop the release of an egg. It also works by thickening cervical mucus (to prevent sperm from being able to reach an egg) and by thinning the lining of the uterus, so that if an egg was fertilised it would not be able to implant.

How effective is it?

The contraceptive injection is over 99% effective in preventing pregnancy.

Advantages of the contraceptive injection

  • It does not interrupt sex.
  • Lighter or no periods.
  • Reduced period pain and fewer premenstrual symptoms.
  • Research also suggests that it provides some protection against womb cancer and pelvic inflammatory disease.

Disadvantages of the contraceptive injection

Using the contraceptive injection can disrupt periods, cause irregular bleeding, and for some women cause periods to be heavier and longer.

Other side effects include headaches, mood changes, weight gain, spotty skin and breast tenderness.

Once the injections stop it may take up to a year for fertility to return to normal.

If started at a very young age, the contraceptive injection may also stop bones from reaching their full thickness, which may lead to problems in later life for women with osteoporosis. However, the evidence for this is not very strong.

Hormonal implant

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The implant is a match-sized bendy stick which is placed just under the skin in the upper arm. It releases the hormone progestogen into the bloodstream.

It’s a long-term method of contraception which works for up to three years.

How does the implant work?

  • It prevents eggs from being released (stops ovulation).
  • It thickens cervical mucus to prevent sperm from being able to reach an egg.
  • It thins the uterine lining so that if an egg was fertilised it would not be able to implant.

How effective is it?

The contraceptive implant is over 99% effective in preventing pregnancy.

Advantages of using the contraceptive implant

  • There’s no need to remember to take a pill.
  • It does not interrupt sex.
  • Lighter or no periods, with reduced period pain and fewer premenstrual symptoms.
  • Research suggests that it provides some protection against womb cancer and pelvic inflammatory disease.

The implant is also generally safe to use in people who are overweight, who smoke and who have a family history of heart disease.

Disadvantages of the hormonal implant

  • It can disrupt periods, cause irregular bleeding, or cause periods to be heavier and longer.
  • Possible side effects include headaches, mood changes, weight gain, spotty skin and breast tenderness.
  • Some women will experience discomfort on insertion and removal of the implant, though local anaesthetic is usually used.

Things to bear in mind

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  • LARC methods do not provide any protection against STIs, including HIV, as a condom does.
  • The contraceptive injection may not be suitable for women aged below 19 because bone development is still taking place. You will be advised about the risks of osteoporosis before you’re prescribed the medication. The injection is not reversible, so if you have side effects you will not be able to stop them until the injection has worn off after 12 weeks.
  • The hormonal implant is a long-term method of contraception but is also suitable for someone who may be considering getting pregnant in the near future, as there is an immediate return to fertility upon removal. It has to be fitted by a specially trained doctor or nurse, so it may not be available at all GP surgeries or clinics. It’s possible that an infection may happen at the site of insertion, but this is rare.

Cost and availability of LARCs

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The IUD, the IUS, the contraceptive injection and the hormonal implant are all available for free on the NHS. You can only get them on prescription and cannot buy them yourself at a pharmacy.

The IUD and the IUS can be obtained from a GP, a sexual health clinic, a practice nurse or a young person's clinic.